Do general dentists do wisdom teeth extractions and implants?

[ddsis]

Just curious, to all the general dentists, do you perform these procedures or do you refer out?

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[Frychicken]

I do third molar exts on a case by case basis. No implants.

 

[2TH MVR]

At the Corp I work at. In addition to the 2-3 OMS, we have this "Exodontist?" who is a GP with additional training ?!? who also extracts wissies. Just recently we have a few GPs who attended some implant courses (on their dime) who are now placing some simple implants. Our Corp employer is a little slow to adopt GPs doing these procedures as they prefer specialists to do these for medicolegal, reimbursement, etc.

During my PP days .... a GP next to my office purchased a CBCT machine, attended the necessary implant courses and started to place implants. Another GP I know also extracts wissies.

 

[schmoob]

It depends on the complexity.

 

[dentistrydmd]

Yes some do both. I know a dentist who does the implants, wisdom tooth extractions (including impacted), and invisalign in his practice and has his associates do all the other work. He did a one year GPR and has taken a lot of CE. Obviously you need to know what you are doing and have to be able to do all this work at the same level of a specialist. It is all about case selection ultimately. If you wanted to do wisdom tooth extractions I would suggest doing a GPR and/or an intern year for OMFS following dental school and you will acquire a fair amount of experience doing those types of cases.

 

[TanMan]

Just curious, to all the general dentists, do you perform these procedures or do you refer out?

I perform some implants and wisdom tooth extractions depending on expected time of completion. If the implant can be completed in 10-15 minutes, I'll tend to do them. If the wisdom tooth can take 0-5 minutes for completion, I'll do it as well. Depends on compensation and time. If I have an extra few minutes to spare, I may end up taking up the procedure. Too many variables, but to sum it up, procedure time/compensation/available time are the variables I'd look at when to accept/deny a procedure. You might ask why not put risk in there? Risk is built into the procedure time. The more risk, the longer it takes. Inherently, I don't do low compensation/high risk cases.

Edit: Also look at the procedual production/hour. You should be aiming for 2-3k/hour.

 

[dwadeffan]

I perform some implants and wisdom tooth extractions depending on expected time of completion. If the implant can be completed in 10-15 minutes, I'll tend to do them. If the wisdom tooth can take 0-5 minutes for completion, I'll do it as well. Depends on compensation and time. If I have an extra few minutes to spare, I may end up taking up the procedure. Too many variables, but to sum it up, procedure time/compensation/available time are the variables I'd look at when to accept/deny a procedure. You might ask why not put risk in there? Risk is built into the procedure time. The more risk, the longer it takes. Inherently, I don't do low compensation/high risk cases.

Edit: Also look at the procedual production/hour. You should be aiming for 2-3k/hour.

how do you generate 2-3k an hour as a GP?? I am curious how bread and butter dentistry could add up to this

 

[Saddleshoes]

I do 95% of the thirds at our place. I'm good at that stuff.
I farm out any implants that come my way. I'm NO GOOD at that stuff.

 

[TanMan]

how do you generate 2-3k an hour as a GP?? I am curious how bread and butter dentistry could add up to this

If all you had were fills, assuming worst case scenario at 100/fill, 5min/fill, that's 1200/hour. The schedule is not fills only though. Fills are essentially a gap filler. What makes for it are the higher end procedures such as rctbucrn or implant placement, peppered with your exams (don't count things that you don't do such as prophies, because that's not your own production), rctbucrn at 2500/30 mins/5000/hour, implants at 10-15 minutes, 1500-2000... it's easy to generate 2-3k an hour depending on your procedure speed and mix coupled with management of the patient loads.

 

[DrJeff]

3rds, I'm with the "case by vase basis" crowd on this one. Sometimes it may be the apparent difficulty of the case (especially when considering post ext healing discomfort/time) others it may be pt anxiety management (I don't have my sedation permit, but my friendly local oral surgeons sure do, and other times it may just be the patient themselves such as if the have a high "drama factor" when I have been working on them in the past. I still do a fair number of 3rds cases, however there is no doubt that as my career has gotten longer that I am referring more out than I used to

Implants - if it's what would be considered an "easy" posterior case (ample bone, no potential sinus or inf alv nerve issues), ample patient opening, etc, then if there's no patient management issues, I'll place them. Otherwise, I'm referring out.

The longer I have been doing this, the more I realize that some cases that I choose to do increase my stress level more than the added income they may generate, and as such, I certainly refer cases out now that I probably wouldn't have a decade plus ago, and that not because I can't do them, just because I don't want and/or have to do them, and learning and accepting that was a good thing for me

 

[2TH MVR]

my career has gotten longer that I am referring more out than I used to

Otherwise, I'm referring out.

The longer I have been doing this, the more I realize that some cases that I choose to do increase my stress level more than the added income they may generate, and as such, I certainly refer cases out now that I probably wouldn't have a decade plus ago, and that not because I can't do them, just because I don't want and/or have to do them, and learning and accepting that was a good thing for me

It's always the same pattern. Those dentists who are seasoned, experienced and not hurting for every production dollar tend to refer more procedures. Seems like the younger dentists are hungrier, have student loan debt and therefore push the envelop.

Try not to be biased. But as a patient. Who do you want to extract your wissies or place your implant? Informed patients probably know their decision.

 

[Alpha Centauri]

The words of my very successful mentor:

If you want to be the best dentist, pick 2-3 things you can do and be the best you can at them.

How do you feel when you go to a 2 star diner with 5 pages of various food items?

 

[TanMan]

It's always the same pattern. Those dentists who are seasoned, experienced and not hurting for every production dollar tend to refer more procedures. Seems like the younger dentists are hungrier, have student loan debt and therefore push the envelop.

Try not to be biased. But as a patient. Who do you want to extract your wissies or place your implant? Informed patients probably know their decision.

I think that there's more to picking the person to do your 3rds or implants than just education/specialty. If a patient likes you, they may prefer to have you do it than have some "stranger/unknown" specialist. As a GP, if we develop that relationship within a few minutes of meeting the patient, then the idea of someone else having more experience goes out the door.

Patients who think that they are informed should go to the specialist as they are the ones that tend to be pickier and unfortunately, our profession doesn't get paid on answering questions.

 

[rippedbx]

I do almost all 3rd molar extractions. I place and restore almost all implants.
I strongly suggest taking an extensive CE course if you will be placing and restoring implants. And get a CBCT everytime.
As far as 3rd molar EXTs, I did a lot of 3rd molar EXTs including some full bony's in school (our OMS was awesome). I'm not convinced a CE course would be worth the cost because experience has been my best teacher. Start small with partially developed roots with patients under 20 yrs old and work up from there. Use N2O and get oral conscious sedation certified (your patients will like you more). I actually watched 3rd molar EXT on Youtube (yes, Youtube) to understand how many other drs did them and things to think about before the procedure.

I actually look forward to difficult 3rds but difficult implants stress me out.

 

[Daurang]

You can do whatever you want as long as you're competent and comfortable. If you're busy enough doing simple drill and fill with a couple SCRP, RCT, PFM here and there, there's really no time nor need to do more complex procedures. One year my hygienist and I netted almost a million $ just on easier stuffs, and that was way too much work for me already.

 

[2TH MVR]

I think that there's more to picking the person to do your 3rds or implants than just education/specialty. If a patient likes you, they may prefer to have you do it than have some "stranger/unknown" specialist. As a GP, if we develop that relationship within a few minutes of meeting the patient, then the idea of someone else having more experience goes out the door.

Patients who think that they are informed should go to the specialist as they are the ones that tend to be pickier and unfortunately, our profession doesn't get paid on answering questions.

But you do get paid to properly triage the patient and direct them to where they can be treated with predictable success whether that's you or a specialist. I agree that most patients who have a good relationship with their GP would prefer to be treated by that same person. Ultimately it is up to the ethics, morals and "experience" of that GP to decide if they are competent to do that procedure.

But here's the thing with dentistry. It's an island and you are the King/Queen. You make all the decisions unilaterally. A patient does not know if your restoration/procedure is "A" quality or "C". As long as it did not hurt ... you are golden. In reality it is the longevity of said procedure that determines the initial quality of your work. Of course there are some other variables to tx success. Now extracting wissies may not have future negative consequences unless you severe the Inf Alv Nerve, lose the tuberosity, TMJ, etc. but the placement and restoration of implants, RCT, Ortho, etc. These procedures may fail later due to any number of issues ....one being the initial treatment rendered.

And if your procedure fails prematurely through no fault of the patients. Well ... the patient loses.

 

[mmc12]

Even if I had an awesome relationship with my GP, I would still prefer to get my wisdom teeth out by an OMFS, especially if sedation is involved. I don't know of any general dentist who does their own IV sedation (although I'm sure they exist).

I had a choice, back in my later 20s, of getting my wisdom teeth out under local anesthesia vs IV sedation. I am SO GLAD that I got mine out under IV haha.

 

[schmoob]

Even if I had an awesome relationship with my GP, I would still prefer to get my wisdom teeth out by an OMFS, especially if sedation is involved. I don't know of any general dentist who does their own IV sedation (although I'm sure they exist).

I had a choice, back in my later 20s, of getting my wisdom teeth out under local anesthesia vs IV sedation. I am SO GLAD that I got mine out under IV haha.

Like I said, it depends. There are some thirds that are very easily extracted. As long as your not a barbarian with well erupted 1/16 and taking off the tuborosity or fracture the buccal plate, you’ll be fine. Same with well erupted 17/32 with apices nowhere near the IAN, you can remove those without the need to section as a D7140.

 

[MandalorianDMD]

The words of my very successful mentor:

If you want to be the best dentist, pick 2-3 things you can do and be the best you can at them.

How do you feel when you go to a 2 star diner with 5 pages of various food items?

Cheesecake Factory

 

[Cold Front]

Just curious, to all the general dentists, do you perform these procedures or do you refer out?

As a general dentist, I don’t refer out my wisdom teeth extractions. Unless it’s a fully impacted 3rd molar and sitting on top of the IA nerve. No need to be a hero unless you are capable of doing wisdom teeth exts. Know your limits or face a million dollar lawsuit against you if you fail horribly.

 

[TanMan]

But you do get paid to properly triage the patient and direct them to where they can be treated with predictable success whether that's you or a specialist. I agree that most patients who have a good relationship with their GP would prefer to be treated by that same person. Ultimately it is up to the ethics, morals and "experience" of that GP to decide if they are competent to do that procedure.

But here's the thing with dentistry. It's an island and you are the King/Queen. You make all the decisions unilaterally. A patient does not know if your restoration/procedure is "A" quality or "C". As long as it did not hurt ... you are golden. In reality it is the longevity of said procedure that determines the initial quality of your work. Of course there are some other variables to tx success. Now extracting wissies may not have future negative consequences unless you severe the Inf Alv Nerve, lose the tuberosity, TMJ, etc. but the placement and restoration of implants, RCT, Ortho, etc. These procedures may fail later due to any number of issues ....one being the initial treatment rendered.

And if your procedure fails prematurely through no fault of the patients. Well ... the patient loses.

Failure of the procedure can happen with a GP or specialist. The assumption here is that GPs are on a lower level than specialists, but I think GPs can, with enough experience and training, provide treatment to the level/standard of care of a specialist. If that wasn't the case, then in theory, a GP shouldn't do anything except exams, if that... because a prosthodontist might be able to do a direct restoration better than a GP. Or they might just push indirects.

I agree though, leave the complicated stuff to the specialists. Not worth your time to perform complicated procedures unless you're starving for patients or you enjoy doing them regardless of the production.

 

[aaaaa]

Failure of the procedure can happen with a GP or specialist. The assumption here is that GPs are on a lower level than specialists, but I think GPs can, with enough experience and training, provide treatment to the level/standard of care of a specialist. If that wasn't the case, then in theory, a GP shouldn't do anything except exams, if that... because a prosthodontist might be able to do a direct restoration better than a GP. Or they might just push indirects.

I agree though, leave the complicated stuff to the specialists. Not worth your time to perform complicated procedures unless you're starving for patients or you enjoy doing them regardless of the production.

I’ll start by stating that I’m biased but your justification is a little silly. A prosthodontics residency doesn’t focus on perfect crown preps, direct restorations, etc. They focus on advanced restorative procedures like full arch rehabs on dentate patients and advance implant restoration (along with learning other advanced techniques making dentures for severely atrophic mandibles/maxilla). To state a general dentist should in theory not be able to do anything because a pros might be better at it isn’t really true. Every dental school teaches every student to be competent in direct restorations, crowns, simple endo, erupted extractions, etc.
I truly don’t think it’s likely that a general dentist can take out wisdom teeth, place implants, do comprehensive ortho, difficult endo, advanced soft tissue grafting, restore full arch implant cases to the level of a specialist. Just like every dental student learns to do fillings, crowns, basic extractions to a level of competency, every specialist is supposed to complete their residency and be able to do their specialty procedures to a high level of competency. Sure some GPs become proficient at removing 3rds, doing molar endo, etc. But I think saying that “as long as you can complete the procedure to the level of a specialist” is kind of BS. You can’t be as fast, efficient, competent at handling complications as a specialist that focuses on their specialty 4-5 days per week. In the end it’s about $$$, not what’s best for the patient.

 

[TanMan]

I’ll start by stating that I’m biased but your justification is a little silly. A prosthodontics residency doesn’t focus on perfect crown preps, direct restorations, etc. They focus on advanced restorative procedures like full arch rehabs on dentate patients and advance implant restoration (along with learning other advanced techniques making dentures for severely atrophic mandibles/maxilla). To state a general dentist should in theory not be able to do anything because a pros might be better at it isn’t really true. Every dental school teaches every student to be competent in direct restorations, crowns, simple endo, erupted extractions, etc.
I truly don’t think it’s likely that a general dentist can take out wisdom teeth, place implants, do comprehensive ortho, difficult endo, advanced soft tissue grafting, restore full arch implant cases to the level of a specialist. Just like every dental student learns to do fillings, crowns, basic extractions to a level of competency, every specialist is supposed to complete their residency and be able to do their specialty procedures to a high level of competency. Sure some GPs become proficient at removing 3rds, doing molar endo, etc. But I think saying that “as long as you can complete the procedure to the level of a specialist” is kind of BS. You can’t be as fast, efficient, competent at handling complications as a specialist that focuses on their specialty 4-5 days per week. In the end it’s about $$$, not what’s best for the patient.

This goes under the assumption that all specialists are highly skilled at what they do. Just like GPs, there are definitely good and bad among the specialists too. Doing things for money and providing a said service is part of any business transaction with dentists/providers (or any service based industry for that matter). Making money and delivering a service; there's nothing wrong with that, but delivering a defective/poor service is definitely an issue. Thankfully, clinical acceptability is a spectrum, and the level of a specialist is also a spectrum. As long as it meets the minimum clinical acceptability of a specialist (which can sometimes be downright borderline malpractice), GPs should be able to take on many procedures that were once seen as "specialist only". On a side note, I wish people would stop demonizing the pursuit of money. To new grads out there, there's nothing wrong with making money, but make sure you don't generate future liabilities in making that money.

This is why I don't do advanced prosthodontic procedures. Per hour compensation is not as high as single tooth dentistry, liabilities generated are higher, and redos are ridiculously expensive.

Now, if you do enough of said procedure, I think you can be "fast, efficient and competent", in terms of handling the procedure and complications. That's the great thing about being a GP - pick and choose your battles. Eventually, you'll learn what to take and what to punt. To say that only a specialist should do x procedure... that's a good way to losing referrals. It may not matter for those GPs that refer nothing, but I'm not in that camp. I use prosth as an example, because many prosths ditch the prosth designation and practice as GPs.

 

[dPseh]

Even if I had an awesome relationship with my GP, I would still prefer to get my wisdom teeth out by an OMFS, especially if sedation is involved. I don't know of any general dentist who does their own IV sedation (although I'm sure they exist).

I had a choice, back in my later 20s, of getting my wisdom teeth out under local anesthesia vs IV sedation. I am SO GLAD that I got mine out under IV haha.

My boss is a GP that does IV, and I once took a sedation course where half the room was filled with GP’s doing IV, so they’re out there...!

For the original question, my boss takes on all sorts of extraction cases that most GP’s would refer out. Example: fully formed, complete bony thirds that are horizontally or vertically impacted. Just yesterday, I saw him take out fully formed impacted #6/11 that were lingually and horizontally positioned behind 7/10. Ridge augmentations, tori removal, etc. The one and only time I’ve seen him refer to an OMFS was for a large max torus removal.
Does his own implants, even occasional gingival grafts/lip repositioning, and endo. No ortho in this office.
Can’t comment on the complexity of the implant cases since I’m a bread/butter dentist.
Would personally trust him with anything he currently does except endo. (Not that he does a terrible job, but I would feel more comfortable in the hands of an endodontist.)

 

[aaaaa]

This goes under the assumption that all specialists are highly skilled at what they do. Just like GPs, there are definitely good and bad among the specialists too. Doing things for money and providing a said service is part of any business transaction with dentists/providers (or any service based industry for that matter). Making money and delivering a service; there's nothing wrong with that, but delivering a defective/poor service is definitely an issue. Thankfully, clinical acceptability is a spectrum, and the level of a specialist is also a spectrum. As long as it meets the minimum clinical acceptability of a specialist (which can sometimes be downright borderline malpractice), GPs should be able to take on many procedures that were once seen as "specialist only". On a side note, I wish people would stop demonizing the pursuit of money. To new grads out there, there's nothing wrong with making money, but make sure you don't generate future liabilities in making that money.

This is why I don't do advanced prosthodontic procedures. Per hour compensation is not as high as single tooth dentistry, liabilities generated are higher, and redos are ridiculously expensive.

Now, if you do enough of said procedure, I think you can be "fast, efficient and competent", in terms of handling the procedure and complications. That's the great thing about being a GP - pick and choose your battles. Eventually, you'll learn what to take and what to punt. To say that only a specialist should do x procedure... that's a good way to losing referrals. It may not matter for those GPs that refer nothing, but I'm not in that camp. I use prosth as an example, because many prosths ditch the prosth designation and practice as GPs.

I’m not saying that only a specialist should do “X” procedures. But there should be a minimum level of training to do certain procedures after dental school, and not always necessarily a residency. Saying “well it’s to the level of a specialist because fortunately it’s a spectrum and some specialists suck” is really really sad and isn’t really true. If some endodontist has a perf every other root canal, that’s not the level of a specialist. Regardless of whether a certain specialist is or isn’t skilled, at least they’ve had minimum basic training (most for several years), and if they’re horrible while in residency they can and should get booted out (that actually happens in a residency but not a CE course😉. Whether it’s a gpr, or a CE course or a mini residency that approved by a board there should be more training and some proof of being competent.

Another problem is that there is no real oversight. The dentist is the gate keeper and unfortunately doesn’t always give all the options. In medicine there is at least some over-site, you can’t go deliver a baby, cut out a tumor, put someone to sleep in the hospital because “Youre a doctor and you have your MD”. You have to be approved by the hospital to perform your specialty. They won’t approve for an OB to start doing general anesthesia one day because the OB clinic is a little slow. In dentistry, if youre slow and decide to start doing comprehensive ortho or all on 4 or whatever you can do it with no extra training. That is crazy. Ensuring someone has a minimal level of clinical training for advanced procedures doesn’t exists in dentistry, except maybe iv sedation. Ive had patients tell me they thought their dentist was a specialist because they only advertise ortho or implants or root canals or whatever. Their dentist told them they were very well trained to do a procedure which was not true. That happens, I’ve seen it, unfortunately I only saw the patient after a complication happens or when they seek a second opinion. And to say some specialist level care is on the level of malpractice is interesting. I’ve unfortunately had to treat multiple complications where malpractice was claimed in court against the doctor who originally performed the procedure and had a horrible complication. None have been from specialists.

 

[2TH MVR]

Well. This is turning into that age old debate on specialist vs. generalist. Plenty of good arguments on both sides. I tend to err on the side of idealism as taught in DS and others have a more realistic view point based on practicing in the trenches.

I like what @TanMan preaches about doing those procedures that are productive AND efficient for his abilities. He runs his practice to a high degree of efficiency which translates into high production and collections. He stays aways from questionable procedures that have the potential for less success which in turn requires additional Dr time which means less ROI. This to myself is the model for all GPs. But what I can surmise is that he is also fortunate through his marketing, etc to have an abundance of new patients making selection of profitable procedures easier.

What scares me is these newer, less experienced, DS tuition strapped younger dentists. Some are casting a large net for new patients since they do not have the luxury of endless new patients like TM. Some think that because they attended a super DS such as MWU, attended some weekend CE .... they can now offer Invisalign, Sleep Dentistry, Implants, Advanced Cosmetics, Botox, TMJ. You know. Those procedures that are generally not bread and butter stuff. They haven't been in practice long enough to develop any experience or had the fun experience of possible board complaints/malpractice litigation.

Heard the phrase? YOU ONLY KNOW WHAT YOU KNOW. I remind myself of this all the time in all walks of life. The bottom line is that the knowledge, education and experience of a GP is most likely going to be less than that of a specialist. Sure. There are some bad specialists just like bad GPs. But the the specialists will probably know a "little" more (I'm being nice 😉 ) about treating specialty procedures as compared to a GP.

Even specialists can get into trouble with adding additional procedures to their scope of practice. I recall an orthodontist who advertised that he was a specialist in orthodontics, Sleep dentistry (btw: most orthos have been moving mandibles forward which opens the airway for decades), and TMJ. Maybe he had the proper credentials. Maybe not. Personally. I enjoy bread and butter orthodontics.

 

[Cold Front]

What scares me is these newer, less experienced, DS tuition strapped younger dentists. Some are casting a large net for new patients since they do not have the luxury of endless new patients like TM.

This is the future. Schools are graduating students with fewer and fewer requirements every year. Covid19 will make that worse.

 

[TanMan]

I’m not saying that only a specialist should do “X” procedures. But there should be a minimum level of training to do certain procedures after dental school, and not always necessarily a residency. Saying “well it’s to the level of a specialist because fortunately it’s a spectrum and some specialists suck” is really really sad and isn’t really true. If some endodontist has a perf every other root canal, that’s not the level of a specialist. Regardless of whether a certain specialist is or isn’t skilled, at least they’ve had minimum basic training (most for several years), and if they’re horrible while in residency they can and should get booted out (that actually happens in a residency but not a CE course😉. Whether it’s a gpr, or a CE course or a mini residency that approved by a board there should be more training and some proof of being competent.

Another problem is that there is no real oversight. The dentist is the gate keeper and unfortunately doesn’t always give all the options. In medicine there is at least some over-site, you can’t go deliver a baby, cut out a tumor, put someone to sleep in the hospital because “Youre a doctor and you have your MD”. You have to be approved by the hospital to perform your specialty. They won’t approve for an OB to start doing general anesthesia one day because the OB clinic is a little slow. In dentistry, if youre slow and decide to start doing comprehensive ortho or all on 4 or whatever you can do it with no extra training. That is crazy. Ensuring someone has a minimal level of clinical training for advanced procedures doesn’t exists in dentistry, except maybe iv sedation. Ive had patients tell me they thought their dentist was a specialist because they only advertise ortho or implants or root canals or whatever. Their dentist told them they were very well trained to do a procedure which was not true. That happens, I’ve seen it, unfortunately I only saw the patient after a complication happens or when they seek a second opinion. And to say some specialist level care is on the level of malpractice is interesting. I’ve unfortunately had to treat multiple complications where malpractice was claimed in court against the doctor who originally performed the procedure and had a horrible complication. None have been from specialists.

I've seen plenty of bad work come from certain specialists and I know not to refer patients to them. Would I ever tell the patient that the work was crap? Never. I think you put all specialists on a pedestal, when there's good ones and bad ones out there. I can tell you for OS's, I know who's greedy and will put in as many implants as possible, who pushes for restoration of implants even with severe bone loss and periimplantitis, who's nice but has a high rate of paresthesia, who has high rates of dry socket, etc. Same with ortho, one will put brackets on anything and everything, even with gross decay and uncontrolled perio AND finish cases unsatisfactorily, some who torque too much and sometimes cause necrosis on upper anteriors, and so on... Every specialist has their strengths and weaknesses. As I tell my specialists, whatever you give me, I will make it work. Even if it's a specialist that I haven't interacted with much, I don't pry into details, just a basic question or two and I'll make it work.

So, on the outside looking in, as a GP, I get to see all the f'ups of the specialists and I'm sure they get to see all the GP's that mess up too. To err human. Anyone who says otherwise is lying and that's why I'm skeptical of some CEs where all they show are good results and no bad ones.

What you talk about is what's great about dentistry - autonomy. You don't have that as much as an MD unless, of course, you have your own surgical center. That's the best thing about being a dentist-GP. Autonomy.

 

[ToothJockey]

My boss is a GP that does IV, and I once took a sedation course where half the room was filled with GP’s doing IV, so they’re out there...!

Is this deep sedation? What kind of drugs do you guys administer?

I ask because I've read on these forums that MD anesthesiologists want to take away sedation privileges from OMFS who have done 5+ months rotation in Anesthesia residency. I wonder what they will think of GP's doing sedation after taking a sedation course.

 

[schmoob]

GP’s can only do moderate sedation. Versed/fentanyl.
You need to be able to handle complications such as the patient going to the next level of anesthesia. From deep sedation, that would be general anesthesia. GP’s and GP offices are not equipped for that.

 

[TanMan]

Sedation makes sense depending on how you are charging for it, frequency, and state regulatory requirements. If you are paid by the encounter, then you need to be able to hook up as many patients as possible (which is the OS model) in a day. If you're getting paid the same for 5 mins vs 1 hour, then it makes sense to go faster. If you are charging by the hour, then the number of patients doesn't matter as much as the number of billable hours generated (can you hook up more than one patient at a time based on your state regulatory requirements running simultaneously) or is it to unlock phobic patients for larger case treatments.

I gave up my sedation license exactly for these reasons. Increased regulatory requirements decreased production potential and attracting the wrong type of patients for my practice. GPs can do moderate enteral/parenteral sedation, but it has to make business sense. I know of an OS here that would sedate till blue, do his thing, and get the patient back up asap. For me, too much to risk, not enough to gain, especially if you're pushing IV deep/GA levels.

 

[dentistrydmd]

huge risk in doing moderate to deep sedation in dentistry.

 

[Saddleshoes]

huge risk in doing moderate to deep sedation in dentistry.

Truth!!!

And the insurance companies are very aware if this. IF you elect to do in office sedation you will have a very steep increase in your rates.

(Some years ago I ran the numbers and found I would need to triple my surgical, procedures needing sedation, to cover the increase in insurance. In my small town practice it just wasn't an economic possibility.)

 

[OliviaBlakeM]

To be honest, I only know that dentists can remove wisdom teeth, but in my opinion this is the only thing that can be done with them. Perhaps if you consult with a specialist, you will get a more accurate answer.